All right, let's get started.
Thank you all very much for joining, uh, this morning on a very short notice.
I don't assume that we have a huge emergency pending, like,
more or less exactly four years ago, which is interesting.
Um, maybe Maria will come back to that one.
but the point is that Maria has an appointment
at 1030 but she can't join the regular briefing.
And we wanted this to be a bit more extensive than just five minutes at the pale.
Um, and today, with possibly large focus on Gaza, we thought we better
um, thank you all for joining.
I see the interest is big, and that's that's good, because, uh, in the recent weeks,
all the the the things we want to talk about
the respiratory illnesses, the flu,
Uh, covid, uh, blocked up hospitals, I think have been
in the media, and people have experienced it themselves.
Uh, nearly everybody knows somebody who's who's sick these days.
So and with this very glad that, uh, doctor Van
of Maria could join us today. You all know her as a covid focal point.
but she's now the other interim
director for Epidemic and Pandemic Preparedness and
So thank you, Maria, for joining us. And that's fantastic. And let's get started.
Thanks, Christian. So Hi, everybody. Um,
thanks for having me back.
I was reflecting with Christian, uh, yesterday that almost four years ago to the day
pet briefing I've ever done.
And first press conference I've ever done. So
I cannot believe it's, uh, four years later,
and I can't believe we're in the fifth year of the pandemic.
just a point of reflection and a point of thanks for all of
you who have been covering this for four years into the fifth year.
Thanks for the work that you do
for communicating really difficult topics to
interested audiences. Um, we need you.
Uh, we continue to need you, so I just wanted to to start off with some Thanks.
wanted to just give a brief overview of sort of where we are in terms of covid,
but also in the context of other circulating respiratory, uh,
pathogens and most notably, uh, influenza.
So I wanted to cover a couple of things with you and then happy to do, uh, Q and a, um,
So I think what's really critical right now
is that the world understands that covid,
uh, the the public health risk from covid remains high,
Um, we have a pathogen. Um, that is circulating in all countries.
we have ranges of percent positivity from our
sentinel sites of anywhere from 8 to 10,
Um, from non sentinel sites up to 18%.
Um, case based data that is reported to WHO is not a reliable indicator.
It has not been a reliable indicator for a couple of years now.
And so if you look at the epic curve, it looks like the virus is gone. And it's not,
um, according to wastewater estimates that we have from a number of countries,
the actual circulation of SARS covid two is anywhere between
two and 19 times higher than what is being reported.
So the virus is circulating.
Um, and what's difficult right now is that the virus continues to evolve.
So we are two years into omicron.
Um, we have a virus that will continue to change as we let it circulate.
um, What is concerning? Uh, I'll start with the positive side. On the positive side,
um, the numbers of deaths have reduced drastically, um, since its peak, um,
a couple of years ago, but we still have around 10,000 deaths per month,
and that's only data from 50 countries.
Among those 10,000 deaths reported in December,
more than half were reported from the United States of America.
deaths in countries from around the
world because countries aren't reporting deaths.
Doesn't mean that they're not happening.
We have had a 42% and a 62% increase in hospitalizations and IC U admissions.
Uh, when we look at the data from December compared to November,
we don't have data into January yet.
Um, and with the holiday season, with the gatherings around the new year,
we expect those numbers to continue to increase.
Um, so while we on the one hand, we are seeing reduced impact,
we feel that there is far too much burden in countries, um,
from covid when we can prevent them, um, with adequate tests with adequate, uh,
access and use of antivirals.
Um, with appropriate clinical care, medical oxygen and, of course, vaccination.
Um, we'll come back to vaccination in a moment.
Um, the other challenge that we face in this winter season,
particularly in the Northern Hemisphere,
is that we have co circulation of a large number of other pathogens, including flu,
um, RSV, adenovirus, rhinovirus, and a number of bacteria mycoplasma pneumonia,
which you've heard about from a number of countries, which goes in 4 to 5 year cycles.
And we're in a cycle of mycoplasma pneumonia causing pneumonia among Children,
uh, while we're not in the crisis, um,
we and we're not seeing the levels of impact that we saw in
the peak of the pandemic in 2021 2022 and even early 2023.
Um, covid is still a global health threat,
and it's causing far too much burden when we can prevent it.
So we're seeing impact on a smaller scale to previous waves.
But now the preventable burden of COVID-19 is
adding to the burden of other respiratory diseases as
deposed to previous years when we had public
health and social measures which were in place.
And so we have to consider covid with flu with all of these other pathogens.
And here's why we're still in a pandemic.
One is the virus continues to evolve.
Uh, we do not yet have a predictable pattern or seasonal pattern with covid.
Um, there's basically two groupings of viruses that are circulating. Right now.
We have the XBB sub lineages, and we have the B a 286 sub lineages.
VA 0.2 0.86 sub lineages and most notably,
JM 0.1 is increasing JM 0.1 represents around 57%
of the global sequences that are shared with
and are analysed by WHO and our technical advisory group for virus evolution.
and this varies, uh, by different regions.
Um, the second reason we're still dealing with covid and that, uh, covid is causing,
an impact is because it's not the only pathogen
that's out there that I've already talked about.
We have co circulation of other pathogens.
Um, despite reduced reporting from countries, the virus is still infecting.
It's reinfecting. It's killing
um, suffering from acute disease represented by people in hospital.
And right now we estimate that there are
hundreds of thousands in hospital for covid.
Uh, we have limited data around the world, and in fact,
the data that we have on hospitalizations only comes from
29 countries out of 234 countries and territories.
Data on IC U admissions only comes from 21 countries out of 234.
So we're really we have very little visibility on impact,
but from those limited number of countries,
there are hundreds of thousands in hospital right now.
Um, so we're worried about the acute disease,
but we're also worried about post covid condition.
from some recent meta analysis suggesting that 6% of symptomatic infections
will result in post covid condition.
Um, and the the burden of of post covid condition affects multiple organs.
Um is very debilitating to people who suffer from it
anywhere from four months to 12 months and even longer.
and we don't know the long term impacts
of repeat infections separate to post covid condition.
People are getting reinfected.
You're getting reinfected I'm getting reinfected. I may not know it.
periodically, especially any time that I have symptoms I test,
Um, but because I have some
I have some immunity from vaccination and previous infection,
as do you. We don't necessarily know how often we're getting infected.
And our concern is in five years from now, 10 years from now, 20 years from now,
what are we going to see in terms of
cardiac impairment of pulmonary impairment of neurologic impairment?
We don't know. We don't know everything about this virus.
It's year five of the pandemic, and I know it feels a lot longer,
but there's still a lot that we don't know about it.
And we're worried about, um the long the acute effects, post covid condition
and even the longer term effects going into the future.
We're also still in a pandemic in a
dynamic situation because there is complacency out there.
Um, a lot. Most people don't want to talk about covid.
And I think the main reason for that is because of the trauma that we've gone through.
There are some serious mental health impacts from this, um,
virus from the last four years whether you're
directly impacted Lo losing a loved one.
but all of us have been impacted by this.
there is complacency that's out there to not want to talk about it.
Our role as WHO is to work with governments to ensure that
the legacy of covid in the strengthening of surveillance systems of clinical care,
of community protection of infection prevention control,
um is maintained to deal with current and future threats.
And we are still in a dynamic situation still in, uh,
seeing impact where we shouldn't because we have very low demand for vaccination.
The coverage of vaccination, um, around the world is, uh, low,
if we look at the booster coverage, um,
we have a number of countries. I have to put my glasses on here.
around the world have received a booster.
What I can't tell you is when they receive that booster,
the oldest adults need to be boosted every 6 to 12 between six and 12 months.
Um, and the coverage around the world, particularly in older groups
Um, in the Americas, it's 65%. In MO, it's 27% in euro, it's 69%
in CRO, 30% wero, 75%. So there's much more that needs to be done.
Health care worker coverage in terms of booster is even lower.
So we're not utilising the vaccines, um,
that are safe and effective and effective against, um, the circulating variants.
So there's a lot more we feel that needs to be done.
Um, just a quick note on influenza.
The Northern Hemisphere is seeing a rapid increase in influenza activity,
North America, North Africa.
Um, although influenza activity might have peaked, it's still high in East Asia,
increasing flu activity might impact the
health care capacities in some countries,
and in fact we are seeing it.
In fact, it impact and a burden in some in some
as well as RSV in the younger age groups RSV may be is still high,
but it may be declining in some countries
if we look at percent positivity for influenza.
Uh, in week 51 of 2023 it was around 20 almost 21% in the Northern Hemisphere.
Um, and then the last two weeks of data are going to be backfilled,
so it's not an accurate representation, but around 15 to 20%.
So there are a lot of viruses that are out there.
Flu vaccination coverage is not as high as it should be as well.
So the message big messages around getting vaccinated against flu,
getting vaccinated against covid, using two tools masking, stay home if unwell,
seek clinical care, improve ventilation.
All of the same messaging that we've had over the last four years.
Still apply may not be as
but it's really important that we get that consistent message out there.
I think Christian, maybe I should stop there and just maybe take some questions.
Thanks so much, Maria. Um, and if because there were a lot of figures in there
I, I would assume that's one of the first questions.
Is there a way you could share the the talking points to the main figures
afterwards? I know you. You normally work in a different way. You know the script. So
if there's a way we can get that, or at least a link to the main data other than the
but we know that would be great. Um,
um, we promised Maria and also the
pale to do not do too long because, um uh,
we need to prepare for Pale. And Maria
So we have about 15 close to 20 minutes, and then let's get started first.
Uh, Christiana, please go ahead.
Uh, thank you, Christiane. My question is on the post covid conditions.
Maria, that you mentioned.
Can you be a bit more specific? You said 6% of symptomatic infections.
Now, I'm one of the very few people in the world who has never been infected,
as far as I know, so I don't know what the symptoms are,
but the people I do know who have been infected say
they had flu like symptoms. Are you
anyone? 6% of anyone who has flu like symptoms light light, I would say symptoms.
6% of all of those people
might have post covid conditions or or is the
group. The 6% refers to a smaller group of people who have
And what What? What are those post covid conditions, for example?
thanks for the question and allowing me to clarify. So post covid
the 6% refers to symptomatic individuals with covid.
So who've been diagnosed with covid who've had
who have been infected with SARS covid two
not people who have had influenza like illness.
there are other estimates that suggest one in
10 infections could result in post covid condition.
an infection could range from anything from
asymptomatic all the way to severe disease.
covid symptomatic individuals.
Post covid condition is defined as,
um people who Ha, We have a case definition for this,
and we can provide that case definition for you,
which we're asking clinicians to use around the world.
Um, so that we have a consistency in understanding what post covid condition is
typically what post covid condition is or long covid if someone has been, has has in,
Um, which could be fatigue,
Um, you know, for example, we know people who were athletes,
premier athletes who can't exercise, uh, anymore.
There's lung impairments. There's neurologic impairments,
Three months after that acute disease that they experienced.
So they had covid, they got better. They got worse.
Um, And people, um, who have post covid condition
that condition lasts anywhere from 4 to 12 months or sometimes even longer.
so there's a lot of work that needs to be
done on on recognising what it is for having cohort studies
around the world to better describe what post covid condition
is and to have better treatment for this as well.
So there's a lot of work, um, in this space, which we don't have enough attention on,
we certainly don't have enough financing around the world on
thank you very much. Maria
Very much so. A couple of, uh, fast questions, Uh, first about masks in Spain. Uh,
the government is requesting, uh, wearing masks again in the hospitals.
Do you think this is enough? Or it should be also requested in other public places.
And my second question is on booster doses.
Uh, WHO still recommends only these to vulnerable groups. Or, uh, to,
uh, all people in general. Thank you.
Thanks. So two quick answers.
So, with regards to masks, our recommendation,
which is still in place since early 2020.
UM, sometime in 2020 is universal masking in health care facilities,
which means anyone in health facilities should be wearing a medical mask.
People who are health workers who are working with covid
patients or suspected patients need to be wearing further,
So respirators or masks, um gloves, face shields,
the whole the whole gamut of of personal protective equipment.
We also recommend the use of masks in communities for people who are at a higher
risk of developing disease.
Anyone who is sick, um, we would recommend wearing a, uh,
a medical mask or a three layered mask when you're around,
others to prevent the spread.
Um, but especially if you're in an older group and if you're in some close quarters.
If there's poor ventilation,
our recommendation still is to to consider wearing masks.
We would like people to wear masks because we
know that they have some effect of preventing onward spread
spread and also, um, uh protecting you from infection
with regards to, uh, additional doses.
So the sage recommendations that came out a few months ago
we make recommendations based on risk category. We have the highest risk groups.
because our recommendations are for the world.
We would like everyone in the highest risk group. So oldest age groups.
So over 75 or 80/60 with underlying conditions.
Um, immunocompromised individuals in all countries to receive a dose,
if you haven't had one in the last 6 to 12 months,
and then we go down and medium risk and then we have lower risk.
We don't recommend the entire planet to get a vaccine.
because we have limited supply and because we because we have access issues
and so our considerations around the highest risk groups in all countries,
we do know that there are national policies.
There are different national policies in different countries.
advocate for the use of vaccines to prevent,
um, severe disease and death,
the vaccines based on the ancestral strain,
the bivalent vaccines and the monovalent XBB vaccines that are coming online.
Now, they all protect against severe disease and death,
and we advocate for their use to reduce the burden and to keep people alive.
Thank you very much, Maria.
And to add you, you may have seen, uh, various hospitals or healthcare.
Geneva are now also starting to wear
masks again as a as a rule, sometimes sometimes in personal protection.
the tour, for example, they they started that with their employees again,
uh, and so on and so forth. So the the the the masks are coming back more visibly.
Uh, next is, uh, Stefan board.
thank you very much. Thank you, Maya, for holding this briefing.
Two questions. Uh, first, uh, I think WHO, uh, published a figure saying that
7 million people, uh, 7 million deaths,
uh, due to covid and influenza. Could you break down big?
More or less The figures.
And if it's correct, And my second question is about you talked about vaccination,
and we know that it's a very hot topic in the,
uh, negotiations about the pandemic accord.
Uh, is are there better infrastructures today, uh, to, you know, to,
uh, allow vaccination to take place. Thank you very much.
Thanks for the two questions.
So this there, the 7 million deaths are covid specific.
Um, so by the end of 2023
31st of December more than 7 million people,
um, have been reported to WHO as having died from COVID-19.
Um, we know that that number is certainly higher.
Um, we are working, um, to estimate what this is.
We have estimates up to the end of 2021.
have been are being revised to look at excess deaths
for 2022 and will be done for 2023 as well.
So we, um, expect, uh, that the actual true number is at least three times higher.
So those 7 million deaths are covid only,
um, which is truly astonishing.
Um, with regards to infrastructure and vaccines.
Yes. Um, you know, you know, we're not in the same position we were four years ago.
there's a lot of work that's been done in
terms of looking at different platforms of vaccines.
The vaccines for COVID-19. Many of them are the MRN a platform.
But there are other technologies that are out there.
Um, there is improvements in production
in terms of production facilities of vaccines.
Much more work needs to be done here, though, um,
And how there's a lot of questions how this
is going to be sustained in terms of financially.
there is some, uh, improvement in terms of sharing, uh, technology.
Uh, but that needs to improve.
So the short answer to that is yes, We're in a in a in a better place.
There's more attention to this,
but we're nowhere really where we need to be. Um,
if if we're in a similar situation or I
should say when we're in a similar situation again,
more planning needs to be.
And I think the discussions with the the accord are quite interesting in this,
but also the work of the CT a,
um the work that we're doing related to access
to medical countermeasures for pathogens with epidemic and products.
Uh, we focusing on pathogens with epidemic and pandemic potential.
And, of course, we have a different system for influenza. So
yes, and no, uh, I think is my answer to that.
Thanks, Maria Lisa from west of America.
Hi. Good morning, Christian. Good morning,
I, uh I got a common cold for the first time in three years, so I'm back to masking
because it lasted three weeks, and it's
uh, my questions have to do with first of all is has Kovac been abandoned,
or is it still operating?
And I'm particularly interested in
the situation as it is in Africa right now,
during the height of the pandemic.
The coverage there, uh, was not particularly good.
So I imagine that it's even worse.
So if you could enlighten us a bit more about what the situation
is and how you're able to keep tabs on what is actually happening
and then, uh, as far as Pax livid goes,
I don't know, keep getting that mixed messages about whether to use not to use.
WHO recommendation on that? Thank you.
Thanks, Lisa. And sorry to hear that you're, uh, unwell.
Um, Hope you're getting better
Yes, Kovac is standing down, and I think Christian, maybe we could provide more.
I'm not the Kovacs focal point, so I don't have the full details on that,
but indeed it is standing down.
Um, and I You're you're correct.
there has been a challenge of getting vaccines covid vaccines in particular,
uh, to the continent of Africa.
we The coverage across the continent is nowhere near
what we had hoped it would have been.
Um, certainly in 2021 2022 and even 2023 now into 2024
when your your question on keeping tabs is a good one because we are
shifting the way that we are going to be reporting on vaccination coverage.
Um, by the springtime springtime Northern hemisphere, Um,
what we will be reporting on is the number of individuals or the proportion
of individuals who received a dose within the last 6 to 12 months,
which is a much better indicator than me telling you how many received a primary
series or a booster because we don't know when that that last booster was given.
it's nowhere near as effective as if it would have
been a year ago or even six months ago.
So we're going to be shifting that
Um all over the world are working to incorporate vaccination into
national programmes so that covid vaccination is not a stand alone,
but that it is actually implemented within
vaccine delivery within the countries themselves,
and this is a much more sustainable model.
Um, but again, it's around working with individual countries,
making sure that we maintain
the gains for vaccination and vaccine delivery.
Um, that have been, uh, that have occurred in the last four years.
And I do maybe not a topic for now.
if at some point we really need to kind of I
know we talk about how many people didn't get vaccinated,
but we also need to talk about how many people did,
you know, in a situation and across the globe where billions of people are exposed,
the entire planet exposed,
and that really is something that is quite astonishing.
Uh, we focus a lot on the hesitancy,
and that's really important because we have to work on that.
But we also should be telling the stories of the
people who've been vaccinated and whose lives have been saved,
because I think that is a positive, uh uh, indicator.
You know, we need to we need to hold on to,
especially with the huge amounts of misinformation that's out there.
and the the reluctance of taking covid vaccine
by some is also impacting flu vaccination.
It's impacting other vaccination programmes.
So we have a lot of work to do in this space in the coming years.
And thanks again. Next on the list is Catherine Catherine Ciano.
Yes, Thank you. Good morning, Christiane. Good morning, Maria.
And thank you for this briefing.
A couple short questions, Um, regarding the long covid. Um,
at the beginning, long Covid was not really identified
So is there a clear process to be identified all over the
world you spoke of about the fact that it is lasting 4 to
that are reporting more cases of long covid?
And is there a lot of cases of long covid among Children?
Yeah, thanks for the question. So, um,
describing long covid globally is very challenging because
many people use different definitions for this.
We have a case definition for post COVID-19 condition, also called long covid.
But the clinical word is post COVID-19 condition
and for Children. So your last question yes.
Children can can develop long covid post covid condition
as well for me to give you an exact I
can't give you an exact number because there's so many
different definitions that are being used around the world.
What we want our clinicians around the world to use our case definition.
clinicians around the world and researchers around the world
are to set up these cohort studies that are
following patients over time to better describe the impacts
of post covid condition on the different organ systems.
Yes, most people will recover after 4 to 12 months,
but there are still some people who are dealing with
these long term impacts for even longer than a year.
So I we don't have the precision that we would
like to be able to describe post covid condition.
We do not have the treatment, um, available yet because it's still so new.
Um, there are a lot of work that's that's ongoing,
and this is led by our clinical management team here at WHO.
We we're working with patient groups as well
to to provide their input into the discussions,
to not only develop, uh, treatments and rehabilitation,
but also to make sure that there's adequate recognition of this because it's real.
This is not in someone's head.
This is actually a real condition that needs to be studied properly.
Thank you. Uh, next I'll take because I hope we have two more questions.
We managed to get through on time, but I'll take first. Gabriella.
Because Ashley is a special guest and she'll get the last question
in case we manage. So Gabriela, please. First.
Thank you. Thank you very much, Maria. Thank you, Christian. I apologise.
I joined the conference late.
I don't know if you talk about this,
but I would like to know if the vaccines recommended by the WHO are the same.
Or have you added any to the list of approved vaccines?
And the second question very quick.
I would like to know if all member states are informing you
about the covid situation.
Um, so second answer first is no.
Uh, we do not have all countries informing us of their covid situation.
with the lifting of the public health emergency last May
and the lifting of national emergencies in some countries,
some countries, um, have stopped reporting.
many are still providing some information whether they're reporting directly
to WHO or they're publishing monthly sit reps online.
we're back to sort of scraping the Web and finding
each of those reports and adding them into our dashboard.
Please look at our new covid dashboard. Um, that we launched at the end of the year.
Over the course of 2024 we're gonna be adding more information,
making the percent positivity coming from our, uh, GR,
system our around the world as well as adding wastewater data to this,
trying to make sure that the death data from countries is
updated because we only have data on deaths from 50 countries.
and we will be incorporating more information on hospitalizations in IC U
because we really want to be focusing on impact on the vaccines.
I'll have to come back to you. Um,
on what? What we have. And I I'm sure we have a website that I can link you to.
I just forgot around the PX
Ovid question for, uh, earlier journalist.
Um, our recommendations for PX
lovi are its use. I can give you the specific recommendation that we have.
Uh, but we recommend the use of, um, antivirals at Pex
to prevent severe disease.
Thank you very much. Uh, and we're managing to get one more in.
And Ashley, uh, who's now with Bloomberg?
Uh, as a special guest today, Please go ahead.
Thanks, Christian. And thanks, Maria.
Um, I just have a quick question about the studies, Um,
in the journal cell from earlier this week on B a 2.86
variant. And there's a concern that there may be a bit more.
Um, it may be a bit more virulent, Uh,
and I'm wondering if you could explain a little bit more about that research.
Um, and if you're concerned about it,
Thank you. Yes. So thanks very much. So that, uh, study that was published.
If it's the same one I'm thinking of,
uh, it was based on a pseudo virus.
So it's not based on JN 0.1 the actual virus itself, but a pseudo virus
And looking at potential severity.
That was considered in the risk evaluation
that we published before the paper actually came
out because the information was shared with
our technical advisory group for virus evolution.
We don't have any indication in people.
Um, that there's a change in severity for JN 0.1.
And right now, as I mentioned in my opening,
that represents around 57% of the global sequences worldwide.
we are concerned and deeply concerned that
this virus is circulating unchecked around the world
and that we could have a variant at any time that would increase severity.
This is not meant to be a a scare tactic, but this is a scenario that we plan for, um,
and the challenge with that.
And if it were to come out in a study,
I think we would see it much quicker in actual hospitalised patients.
Um, and I should say, you know,
we are seeing increased hospitalizations in a number of of countries.
Um, around the world, I had my team pull out, um, where we're actually seeing this,
but quite significant increases in in a number of countries around the world,
not near the peak of what we saw during Covid, but
a variant that that is more severe is a possibility.
And we don't have the agility within our systems to scale up scale down
to get those tests out to be available so
that people can get into the clinical care pathway
access to antivirals to prevent severe disease access to medical oxygen.
We just don't have the flexibility and agility within countries because
people are thinking that covid is no longer a problem.
COVID-19 is a global threat,
especially in the context of other circulating viruses.
But we are looking at all of those studies.
That particular study that you mentioned is included in our risk evaluation.
Um, which is on our website. Um, it was published a few weeks ago.
Um, and you can see that our TABE. Is meeting again on Monday
and we're going to be considering other, um, prepublication data from,
research groups around the world who we're very grateful for
to share this information with us ahead of time.
Thank you very much. And looking at the time, this is just perfect timing.
We'll end it here. Thank you all very much.
uh 12 January 2024 briefing on the co circulation
of covid fluid respiratory pathogens causing increase in cases
with Doctor Maria Van Kirkel.
Thank you very much for being with us. Maria.
Thank you to the UN colleagues to making this happen. at such a short notice.
And thank you all for joining Maria. Have a good day. Everybody else.
I guess I'll see you in a few minutes. Thank you.
Thanks, Christian. Thanks, everyone.